and morbid changes be detected in

rmit us to linger in this tempting very few of the latest improvements ed to indicate the one quality which practitioners as compared with the e should say that it is conscientiousence for the human body, and a r to avoid its infliction. Surgery ive. The man is not now most rforms in the most dashing style

It is almost universally felt that ss serious mutilations, are, in the perfection of the art. He is not was within our recollection, who servation of a finger than in the ›dern surgery thinks it no condenot of disabling deformities only, s, and by various plastic operathe human form divine" its isease. Many of these triumphs se of their tedious and therefore en impracticable but for the ation to the art of medicine, producing temporary unconinvention of human genius the millennium, it is that of servation of life, the amount been saved is incalculable. g in surgical operations, is ity that we are tempted to r of a century has elapsed e use of anæsthetics, and ious, from their own exe of the boon; and this urgeons now in practice. not likely to be read by one who has done ut this blessed change, ter in the art of comof Edinburgh, of the mode of treatment. rites in a letter to Sir on very short warning, I at once agreed

k to prepare for it;

within his reach; that of the saccharine is almost within it; but the albuminous is still beyond."

The application of such researches as these to the Science of Medicine is too obvious to need pointing out. They furnish the only safe basis on which the knowledge of diseased actions and of morbid poisons can be founded. To the latter class of bodies, owing to the unusual prevalence of infectious diseases, special attention has recently been paid, and we seem to be on the eve of brilliant discoveries in reference to some of them. The question is still unsolved whether the poison, or contagium, of the so-called Zymoses, consists of living germs, i.e. entire, although undeveloped, organisms, or of living portions of organic matters, i.e. germinal particles or cells, or of dead matter, peculiarly compounded, and undergoing some special process of decomposition.

For a further extension of our power of research into the chemical constitution of organic bodies, we are indebted to a new application of the Science of Optics. Spectrum analysis now not only tells us of what elements the planets and the photosphere of the sun are composed, but whether certain red spots which may be the subject of medico-legal inquiry, are or are not stains of blood. For this great discovery we have to thank Mr. Sorby, of Sheffield. Dr. Bird Herapath, of Bristol, was the first to employ it in the inquiry into a case of alleged murder. It is impossible in imagination to limit the extent to which micro-spectroscopy may aid us in the analysis of organic bodies.

One of the latest applications of physical science to the purposes of medicine is a further extension of the powers of sight. Endoscopy, in its various forms, by most ingenious combinations of lenses, mirrors, tubes, and, in some instances, increased means of illumination, enables us now to explore all the canals opening on the surface of the body, and even to inspect some of its cavities. The revelations thus made are wonderful, and have far exceeded the expectations of those who first suggested such means of research. It might have been expected that, looking through the window of the Cornea, we might ascertain the exact condition of the internal structures of the eyeball. But who would have imagined that from the morbid changes observed in them we might be able to pronounce with certainty on the existence and nature of disease existing, not only in the brain, but in so remote an organ as the kidney? An amusing instance of the enthusiasm with which this line of inquiry is now pursued was given at the international medical congress which recently sat in Paris. A zealous worker in the field of endoscopy foretold the time when, by means of the lime-light, the whole body

* Dr. Letheby's Introductory Lecture at the London Hospital.- British Medical Journal, Oct. 5, 1867.

would be rendered diaphanous, and morbid changes be detected in its innermost recesses.

But our space will not permit us to linger in this tempting field, and we pass on to notice a very few of the latest improvements in the Art of Medicine. If asked to indicate the one quality which characterizes the present race of practitioners as compared with the majority of their predecessors, we should say that it is conscientiousness, shown by increased reverence for the human body, and a greater wish to diminish pain or to avoid its infliction. Surgery has become eminently conservative. The man is not now most admired by his brethren who performs in the most dashing style the capital operations of surgery. It is almost universally felt that such operations, being more or less serious mutilations, are, in the same ratio, confessions of the imperfection of the art. He is not now liable to be sneered at, as he was within our recollection, who professes greater pride in the preservation of a finger than in the amputation of an entire limb. Modern surgery thinks it no condescension to labour in the removal, not of disabling deformities only, but of disfigurements and blemishes, and by various plastic operations to endeavour to restore to "the human form divine its pristine beauty, lost by accident or disease. Many of these triumphs of conservative surgery would, because of their tedious and therefore additionally painful nature, have been impracticable but for the grandest discovery ever made in relation to the art of medicine, that, viz. of a safe and easy method of producing temporary unconsciousness of pain. If there be one invention of human genius worthy to be called an anticipation of the millennium, it is that of anæsthetics. To say nothing of the preservation of life, the amount of agony from which mankind has thus been saved is incalculable.

This topic, the avoidance of suffering in surgical operations, is one of such surpassing interest to humanity that we are tempted to enlarge upon it a little. Nearly a quarter of a century has elapsed since the introduction into practice of the use of anaesthetics, and of the present generation few are conscious, from their own experience or observation, of the magnitude of the boon; and this may be said even of the large majority of surgeons now in practice. We will, therefore, extract from a work not likely to be read except by professional persons, and written by one who has done more than any other man living to bring about this blessed change, Sir James Simpson, a description by a master in the art of composition, the late Professor George Wilson, of Edinburgh, of the horrors of a surgical operation under the old mode of treatment.

"Several years ago," Professor Wilson writes in a letter to Sir James Simpson, "I was required to prepare, on very short warning, for the loss of a limb by amputation I at once agreed to submit to the operation, but asked a week to prepare for it;

not with the slightest expectation that the disease would take a favourable turn in the interval, or that the anticipated horrors of the operation would become less appalling by reflection upon them, but simply because it was so probable that the operation would be followed by a fatal issue, that I wished to prepare for death and what lies beyond it whilst my faculties were clear and my emotions comparatively undisturbed.

"The week, so slow and yet so swift in its passage, at length came to an end, and the morning of the operation arrived.

"Before the days of anaesthetics, a patient preparing for an operation was like a condemned criminal preparing for execution. He counted the days till the appointed day came. He counted the hours of that day until the appointed hour came. He listened for the echo, in the street, of the surgeon's carriage. He watched for his pull at the door-bell; for his foot on the stairs; for his step in the room; for the production of his dreaded instruments; for his few grave words, and his last preparations before beginning; and then he surrendered his liberty, and, revolting at the necessity, submitted to be held or bound, and helplessly gave himself up to the cruel knife. The excitement, disquiet, and exhaustion thus occasioned could not but greatly aggravate the evil effects of the operation upon a frame predisposed to magnify, not to repel, its severity. To make a patient incognisant of the surgeon's proceedings, and unable to recall the details of an operation, is assuredly to save him from much present and much future self-torture, and to give him a much greater chance of recovery.

"The operation was a more tedious one than some involving much greater mutilation. It necessitated cruel cutting through inflamed and morbidly sensitive parts, and could not be despatched by a few swift strokes of the knife.

"Of the agony it occasioned I will say little. Suffering so great as I underwent cannot be expressed in words, and thus fortunately cannot be recalled. The particular pangs are now forgotten; but the black whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering closely upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so.

"During the operation, in spite of the pain it occasioned, my senses were preternaturally acute. I watched all that the surgeons did with a fascinated intensity. I still recall with unwelcome vividness the spreading out of the instruments; the twisting of the tourniquet; the first incision; the fingering of the sawed bone; the sponge pressed on the flap; the tying of the blood-vessels; the stitching of the skin; and the bloody dismembered limb lying on the floor.

"These are not pleasant remembrances. For a long time they

haunted me, and even now they are easily resuscitated; and though they cannot bring back the suffering attending the events which gave them a place in my memory, they can occasion a suffering of their own, and be the cause of a disquiet which favours neither mental nor bodily health. From memories of this kind those subjects of operations who receive chloroform are of course free; and could I even now, by some Lethean draught, erase the remembrances I speak of, I would drink it; for they are easily brought back, and are never welcome."

"After perusing," continues Sir James Simpson, "such a touching and terrible account of what surgical patients were sometimes called upon to suffer, before the introduction of modern anæsthetics, it is delightful to reflect that all these forms of human agony are essentially ended and abrogated. We now know also and acknowledge that these tortures, so long endured as dire necessities, were of no advantage, but the very reverse, to the patient himself. While anesthetics save the patient from the agonies produced by the cutting of his living flesh, they at the same time preserve his strength and enhance his chances of recovery. But they are not a boon merely to the patient: they are a blessing also to the surgeon himself, as they enable him to accomplish his knife-work far more calmly and deliberately."*

There is one use of anesthesia in which, although it applies only to one sex, we must all rejoice. The pain, often amounting to agony, which, in obeying the first command, "increase and multiply," by a mysterious arrangement of Providence, woman alone endures, may, by the use of chloroform or similar agents be, with perfect safety to mother and child, rendered comparatively insignificant. And by the avoidance of the nervous exhaustion caused by long-continued suffering, life is often saved which, under different circumstances, would have been sacrificed.

Great, however, as have been the blessings conferred by general anæsthetics, their use has its drawbacks. A few persons have succumbed to their depressing effects on the vital energies. The discovery, therefore, of some means which, without producing general unconsciousness, would render the part to be operated upon insensible, had become a desideratum. The want has been supplied in more than one way. The local application, as proposed by Dr. Arnott, of ice or of freezing mixtures, by which the part was temporarily frozen, was a great advance; but the perfection of local insensibility seems to be attained by Dr. Richardson's beautiful invention of ether-spray.

Anæsthetics do more for the surgeon even than this: they save him from possible physical suffering. The writer of this article, when many years since a dresser at a London hospital, had one of his fingers severely bitten by a poor little boy, who was undergoing a painful operation.